Provider Demographics
NPI:1346335395
Name:KATZ, ROBERTA (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2764
Mailing Address - Country:US
Mailing Address - Phone:973-746-6510
Mailing Address - Fax:
Practice Address - Street 1:74 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2764
Practice Address - Country:US
Practice Address - Phone:973-746-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS1003405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
951934Medicare ID - Type Unspecified